Pericardial effusions in children with severe protein energy malnutrition resolve with therapeutic feeding: a prospective cohort study

Shafique Ahmad ^1*, Jane Cathryn Ellis ², Ann Nesbitt ³ and Elizabeth Molyneux ⁴

¹ Queens Medical Centre, United Kingdom
² Nottingham University Hospitals NHS Trust, United Kingdom
³ Community Health, East London, United Kingdom
⁴ College of Medicine, University of Malawi, Malawi

^* To whom correspondence should be addressed. E-mail: doctorshaf{at}hotmail.com.

Accepted 6 May 2008

Abstract

Background: Malnutrition underlies 50% of paediatric morbidity and mortality in sub-Saharan Africa. It is important to look for underlying causes of the malnutrition and some clinicians have assumed that the presence of a pericardial effusion indicates underlying TB. We wished to see how common pericardial effusions are in malnourished children and how their presence or size is related to peripheral oedema or the type of malnutrition of the child, HIV status or to underlying TB.

Methods: We prospectively studied a cohort of children at a regional nutritional rehabilitation unit in Malawi. Echocardiography on admission and follow up four weeks later was performed. During this interval children received therapeutic feeding and any other required medical care. The children were grouped into group 1 (marasmus), group 2 (marasmus with TB), group 3 (marasmic kwashiorkor), group 4 (marasmic kwashiorkor with TB), group 5 (kwashiorkor) and group 6 (kwashiorkor with TB).

Results: Of the 89 children who were enrolled, 28 were marasmic, (8 also had TB), 29 had marasmic kwashiorkor, (6 with TB) and 32 had kwashiorkor (4 with TB). In all the children who had a PE, its size was greatest at presentation. The overall reduction in PE size after four weeks of nutritional therapy was significant (2.9 mm change, range 0 - 8.4 mm, p = 0.002). The greatest change in PE size was in the children with most peripheral oedema compared to those with no oedema (2.7 mm v 1.0 mm, p = 0.017).

Conclusions: In severely malnourished children pericardial effusions are common, larger in children with peripheral oedema and respond to nutritional therapy alone.